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Chronic use of tramadol after acute pain episode: cohort study

BMJ 2019; 365 doi: (Published 14 May 2019) Cite this as: BMJ 2019;365:l1849

Medicine's first duty is to the share holder...well it seems like that.

The present and recent issues of the BMJ have highlighted some of the stock crazies of the medical-pharmacological-corporate world. For example, the marketing of opiates including Tramadol. If you promote opiates like Sackler and Purdue Pharma did in the United States you get 130 opiate deaths a day - marketing works.1 If you give female hormones (contraceptive pill, HRT) to widespread populations you get three things: 1. An epidemic of breast cancer, 2. Plummeting birth rates, 3. Pollution of the water tables with feminization of fish and aquatic life (all documented in national databases with correlations).2 If you promote a TV series detailing teenage suicide like "Thirteen Reasons Why", you get teen suicides and mental health issues in teens. If you legalise cannabis (despite its unproven efficacy in any medical condition save intractable epilepsy in childhood) you fill psychiatric units with psychosis (33% of acute units in London were occupied by skunk users) and do untold harm to developing brains of young people who need to be motivated to achieve their potential (amotivational effect of cannabis). You also make money for manufacturers. Finally if you release Ketamine on the market as the new panacea for depression and let marketing take over you will probably get an epidemic of addiction and side effects. All these interventions are backed by corporate interest. The medical authorities and government were and are no match for vested interest and corporate greed and muscle.

There is urgent need for another voice for the people, an advocate that will protect them from pseudo medicine and the corporate machine. This advocate should be similar to NICE or Cochrane with independence, resources and most of all a guarantee that its primary aim is for the benefit of the health of the community. It needs to have teeth to block expensive industry driven interventions that are unnecessary of doubtful efficacy and are even harmful. This is not happening based on the above debacles and upcoming possible debacles. Complicity, money and absolute silence on behalf of those responsible for safe and intelligent healthcare has allowed health budgets to soar (20% of GDP in USA, averages of 10-12% in Europe), creating the medicalization of many aspects of life and a spawning industry serving the share holders. Medicine is big business and has gone from being a service to the state to being serviced by the state at the expense of ordinary taxpayers. The realistic position for health is in education, prevention, healthy lifestyle and behaviours, good housing and green spaces and employment. Expensive corporate medicine should be way down somewhere like 10th position after a host of other societal needs have been satisfied - instead it is in pole position dictating what health is.

1. Preying on Prescribers (and Their Patients) — Pharmaceutical Marketing, Iatrogenic Epidemics, and the Sackler Legacy. Scott H. Podolsky, M.D., David Herzberg, Ph.D., and Jeremy A. Greene, M.D., Ph.D. NEJM 2019;380: 1785-1787.
2. Breen EG. The Screech Owls of Breast Cancer. AuthorHouse 2013.

Competing interests: No competing interests

15 May 2019
Eugene Breen
Psychiatrist, Associate Clinical Professor
Mater Misericordiae University Hospital Dublin, University College Dublin
62/63 Eccles St Dublin 7